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Student Application

Student’s Name _______________________________ Age: _______
Grade (2020-21 school year): ____  Gender: (circle) Male   Female  Non-Binary ______
Address ____________________City__________ State ____ Zip_______ 
Student’s Phone (____)______________ Email: ____________________ 
Parent/Guardian Information: 
Parent/Guardian (name) _____________________________________
Cell Phone (_____)______________ Email: _____________________ 
Student's Musical Background: 
How long has the student been playing? ___ (circle one) Yrs. Mos. 
Name of the school where student began musical studies:_____________
Who is the student’s medical insurance provider?__________________ 
Snacks are provided at camp. Does your child have any allergies? y or n
If yes, please specify: _______________________________________ 
Important: There will be a hired media team on site capturing footage and images for promotional purposes. Does Kingdom Flute Works have your permission to use your child's image for advertising purposes? If you do not wish for your child's image to be captured please be sure to circle noand if we have your permission please circle yes.Please circle one of the following: yes or no 
Scholarship Applicants: 
Scholarship essays MUST:
1. Be written by the student applicant 
2. Be submitted with the student's application 

Student's signature (REQUIRED): _________________________________

Student's email address: ___________________________

Parent/Guardian signature (REQUIRED): __________________________ 

Parent/Guardian's email address (REQUIRED): ___________________________

Copy, paste, and submit application here --> Contact Page in the 'comment box'